Remember! Our guides are to be used following an assessment with a qualified medical professional. Do not attempt these exercises if you have not been given a formal diagnosis, or given consent to complete these exercises by a Physical Therapist.

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Plantar Fasciitis Physical Therapy Guide

What Is Plantar Fasciitis?

Plantar fasciitis is a very common condition that can cause pain under the heel of your foot. Pain can also spread under the arch of the foot and is often described as a sharp or stabbing-like pain. Pain is often felt when you first stand up after having been off your feet for a while, and is usually worse when first get out of bed in the morning. The diagram shows the plantar fascia which runs from under the ball of the foot and attaches to the heel bone. Pain is the direct result of the plantar fascia being damaged, and becoming inflamed. Plantar Fasciitis is a self-limiting condition, meaning it can often go away on its own accord, but it may take more than a year to do so. Physical Therapy and in particular exercise therapy can speed this process up and hasten your rehabilitation.

What Causes it?

The exact cause of Plantar Fasciitis is still poorly understood, it is often considered to be an “overload” injury normally associated with athletes, however PF is also commonly found in fairly sedentary people. Plantar Fasciitis occurs when the fascia underneath your foot gets damaged, usually when it gets over stretched or over-used. Small micro-tears can occur along the length of the plantar fascia, or where it attaches to the heel bone. It is very difficult to find the root cause of the pain, as pain may commence some days after the moment of injury. Following this, The injury is not something you would associate with a “traumatic” episode like a muscle sprain or leg break, it can be brought on from something as simple as wearing new shoes, exercising more frequently or stepping awkwardly. One thing is for sure, It can be present in sedentary, overweight individuals or very fit athletes. Generally though it is thought to occur when there is an increased load placed on the plantar fascia, either by certain activities (like running) or by a patient’s biomechanics, or a combination of both.

Does It Get Better?

Absolutely! Most cases of plantar fasciitis do not last, however the pain does not often go away overnight. Some people can suffer from this injury for weeks or even years, and often try to work or play through the injury. Reasons for the pain not subsiding include: not resting adequately, wrong shoes, no exercise. As a result, it is important to start your rehabilitation as soon as possible.

Night Splints

Night Splints are carefully designed to place a stretch on the Achilles tendon and plantar fascia whilst you sleep overnight. Their success is variable, like most things in PF. The research shows mixed results, some studies suggested night splints were effective in up to 80% of cases while others showed no change. We find that they are fantastic alternative for patients who are having limited improvement following the exercise therapy guide.

What Are My Treatment Options?

There are many treatment options available to people who suffer with Plantar Fasciitis!

Rest & Time

It is imperative that you stop doing the thing(s) that caused the heel pain to begin with and avoid activities that agitate it further. There are no specific activities to avoid, as it is completely subjective; everyone is different. Throughout your rehabilitation programme you must make note of what to avoid via trial and error. Any time that you feel something is causing the pain to flare up, or if you feel your heel becoming painful you must take care of the injury site and cease the activity. Perhaps the worst thing you can do for this type of injury is to “work through the pain”, Plantar Fascia do not heal in this way and it will only set you back more time if you do.

What About Steroid Injections?

The use of an injection really should be a last resort. Steroid is a potent anti-inflammatory so works well when inflammation is present. There may be some inflammation in acute PF but in more chronic cases it is thought to be a more degenerate condition, like a tendinopathy, with minimal inflammation. The structure of the fascia changes and becomes less effective in managing load. If this is the case an injection is very unlikely to help and injections have been associated with rupture of the plantar fascia.

Physical Therapy

Although rest is a vital component of the recovery process, it doesn’t mean the affected foot has to be completely immobilised. In fact, the Fascia need to be placed under tensile loads to grow and stay healthy. The easiest way to place the fascia under tensile load? Exercise!

Plantar Fasciitis Exercises

1) Calf Stretch

Your calf muscles are located in the back of your lower leg, and are responsible for movements in which your foot points downwards (such as applying the brakes in your car). The Calf is made up of two large muscles called the Gastrocnemius and the Soleus. Having a tight calf is one of the major reasons people develop plantar fasciitis, so get stretching!

How to do it:

Sit on the floor or on your bed with a towel or a resistance loop bandwrapped around your injured foot.

3) Stair Stretch

* Note: This exercise places a lot of load through your achilles tendon! If it increase pain then skip this exercise until you get to the point where it is no longer painful.

The stair stretch is both a stretching and strengthening exercise, and places a great amount of tensile load through the achilles tendon which is often tight in people who suffer from plantar fasciitis. This exercise is for people who are reaching the end of their rehab and aren’t suffering from pain whilst exercising.

How to do it:

Standing on a step or a block with the heels of your feet overhanging the edge.

Slowly allow your heels to continue going in a downwards direction until you feel a comfortable stretch in your calves.

Hold the stretch for 10-15 seconds, before slowly going back to neutral.

Repeat 5 times, three times throughout the day.

4) Deep Plantar Massage

Deep massage is a treatment intended to speed up the recovery process of injuries like plantar fasciitis, which is used by Physical Therapists, but can be performed by the patients themselves. The purpose of deep friction massage is to improve the mobility of the plantar fascia and prevent adherent scars forming. The massage is deep (and quite painful) for people suffering from PF, however the movement encourages realignment and lengthening of the fascia fibres and will improve your recovery time.

Many professionals find it preferable to prescribe foam rollers or Muscle Stick rollers, which can be found here!

5) Toe Scrunches

Once you can feel your pain improving and you are better able to complete exercises that you weren’t previously able to do, then you can progress to strengthening exercises of the foot. This exercise is the easiest and most effective of the lot!

How to do it:

Sitting with a towel or piece of paper in front of you on the floor.

Place your foot on the towel.

Scrunch your toes and arch of your foot, squeezing the towel on the floor

Hold for 5-10 seconds. Repeat 5 times, three times throughout the day.

6) Frozen Plantar Roll

A fantastic home made “remedy” for Plantar Fasciitis pain relief that has very good (short term) results. Ice therapy is used for most injuries and is a mainstay of the RICE protocol for injury management.

How to do it:

Fill up a small bottle of water 3/4 full and freeze it overnight or until solid.

Place it on a towel in front of you whilst sitting down.

Place your affected foot on the bottle, and slowly begin to roll your arches back and forth over the frozen bottle.

Apply more force through the bottle to really massage the plantar fascia.

Repeat twice daily for 5 minute periods.

Can I Return To Running / Sport?

This can be a huge challenge with any injury, and especially so with a painful one like Plantar Fasciitis. The only true way to find out if you’re suitable to return to training, is to try it! Try and find a way to run pain free. This might be shorter distances, running slower, smaller stride lengths etc. or using tape or orthotics. Gradually increase your distance and avoid hills initially. Ideally it should be pain free when running and for around 48 hours after. If your pain increases in this time or the overall trend is that it’s getting worse, you may have to rest until it’s more settled.

Some people will continue to run with PF and others will wait until it’s resolved. It’s up to you! Sometimes PF can take a year to settle and resting from running doesn’t seem to help. In which case you may just want to gradually return and see how you get on. If, however, the rest seems to help a lot, and any form of exercise really aggravates it, it’s sensible to give it a little longer to settle.